Provider Demographics
NPI:1558677674
Name:VERA D. CECILIO, M.D. INC.
Entity Type:Organization
Organization Name:VERA D. CECILIO, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CECILIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-609-7200
Mailing Address - Street 1:5525 ETIWANDA AVE
Mailing Address - Street 2:SUITE 322
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6119
Mailing Address - Country:US
Mailing Address - Phone:818-609-7200
Mailing Address - Fax:818-343-8869
Practice Address - Street 1:5525 ETIWANDA AVE
Practice Address - Street 2:SUITE 322
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6119
Practice Address - Country:US
Practice Address - Phone:818-609-7200
Practice Address - Fax:818-343-8869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26195207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26195OtherMEDICARE PTAN
CAA26195OtherMEDICARE PTAN